Magnetic therapy: another way to treat depression; Side-effects few, but mixed views on its success.
WORCESTER - At 39, Theresa Lubecki has battled serious depression and psychosis for a decade. She tried many combinations of psychotropic drugs and underwent numerous sessions of shock therapy. The end result was always the same, though: the return of the depression, as well as the voices in her head.
But then her doctor, M. Rachid Och of Island Counseling Center in Worcester, recommended a relatively new treatment called transcranial magnetic stimulation, or TMS. Approved by the Food and Drug Administration in October 2008, the treatment involves sending electromagnetic pulses to the portion of the brain that is believed to control depression. The idea, according to Dr. Och, is to try to get some of the benefits of electro-convulsive therapy - also known as shock therapy - without the many side effects that come with inducing a seizure in a patient under general anesthesia.
In TMS, a curved device attached to a long metallic arm is placed on the left side of the head, and the patient is told to look at a dot on the far wall. For 37 minutes, the magnet is turned on, making six loud pinging sounds, then pausing for a minute or so, and then sounding again. The patient wears earplugs to muffle the sound.
For Ms. Lubecki, when the magnet pulses, her right hand twitches slightly. She is awake and alert the entire time. Except for minor headaches, she has had no side effects from four weeks of twice-a-week treatments.
When she finished her last session recently, Ms. Lubecki said TMS had given her her life back.
"I smile, I interact better with people, I can talk to people," she said. "You have to want to get better, you have to want to have your life back. It's not just the machine. It's an attitude."
Ms. Lubecki, a Dudley resident who once worked as a certified nursing assistant, is talking about going back to work. She continues to take one prescription medication for depression.
"I haven't been able to work in 10 years," she said. "I'm very hopeful."
Her mother, Yvonne Lubecki, said the change in her daughter has been remarkable.
"It's like having the old Terri back. She is so calm and clear and able to think things through in minutes rather than days," she said.
Dr. Och, president and medical director of Island Counseling Center, said the center has had the TMS device since November, but has treated only five patients.
"If someone is acutely ill, this is not going to work," he said. "If someone is suicidal or has stopped eating, we'll probably use ECT (electro-convulsive therapy), which gets them better much faster."
This treatment is effective for treating people with serious depression who have not had good results with other treatments, he said.
"Of the five patients we've treated, four have had great success, and have become well enough to stop treatments," he said. The treatment did not lift depression for the fifth patient, but it did not have any side effects, he said.
Dr. Och said Island Counseling is considering using the TMS machine to treat other psychiatric illnesses, such as obsessive compulsive disorder and post-traumatic stress disorder. To treat those patients, the device would be placed on the right side of a patient's head, he said. The TMS treatment is only FDA-approved for depression, he noted, and so patients would have to understand the risks before being treated, he said.
Opinions of TMS as a treatment for depression are mixed.
Dr. Tatyana Shteinlukht, an associate psychiatry professor at the University of Massachusetts Medical School in Worcester, said TMS has been shown to have good results in treating depression. Dr. Shteinlukht said she has never used TMS, and is a proponent of ECT, or shock therapy.
"The studies I've read say that TMS is about 40 percent effective in treating depression," she said. "That is better than a placebo, which is 20 percent. But ECT is around 60 percent effective, and many drugs range in the 60 to 70 percent range."
She said the idea behind TMS, stimulating the section of the brain that controls depression, is a good one.
"The side-effects are less, but the studies say it is less effective," she said.
Andrew Fudderman, an associate professor of psychology at the College of the Holy Cross, said he is skeptical about TMS.
"It's not very invasive, so that's good," he said. "The data doesn't look very compelling, though. It doesn't look very convincing to me, compared to the other treatments out there."
But Mr. Fudderman said depression carries risks with it as well, as depressed patients are much more likely to commit suicide.
Perhaps the largest stumbling blocks for patients seeking TMS treatment are access and insurance coverage. The TMS machine at Island Counseling Center is one of only a handful in Massachusetts, and the only one west of Interstate 495.
And the treatment is not covered by Medicare, nor is it covered by most private health insurance plans. The cost for the initial mapping session is $400, Dr. Och said, and then $350 per session. Most patients will initially be prescribed a dozen treatments or more to treat depression.
The manufacturer of the TMS machine, Neuronetics of Malvern, Pa., has a financing plan to help patients pay for the treatment.
"This hasn't yet become part of American psychiatry," said Dr. Och of TMS. "It's already established in Canada. Sometimes it takes a while for the insurers to catch up with the technology."
CUTLINE: A patient undergoes transcranial magnetic stimulation thereapy as Dr. M. Rachid Och stands nearby.
PHOTOG: T&G Staff/CHRISTINE PETERSON